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Thesis advisor: Kelly Rossetto / Because divorce has become a prominent fixture in society within the last several decades, a significant amount of research has been conducted on divorce and its subsequent effects on the family system. Many of these studies have shown the negative effects of divorce on members of the family, particularly children. Previous literature on coping with divorce has outlined the strategies families use to manage these negative effects. Rather than focusing solely on the negative side of divorce, this study sought to provide a more complete picture of the effects of divorce, including the possibility of positive outcomes. Nine in-depth interviews were conducted with adult children of divorce to examine their feelings about divorce, the factors that contribute to these feelings, and their coping strategies. Changes in family structure, lack of divorce information, role reversal, parents’ sadness, continued conflict, parental disclosure, remarriage, and financial difficulties contributed to participants’ negative feelings of confusion, neglect, anger, sadness, and feeling caught. Having a voice, parental involvement, parents’ happiness, decreased conflict, and remarriage contributed to their positive feelings of empowerment, relief, and closeness with family members. In addition to these factors, coping strategies denial, patience, mediation, role acceptance, open communication, social support, and learning from the divorce also increased participants’ positive feelings and decreased their negative feelings. Overall, participants’ described parental divorce as a continuous and difficult, yet worthwhile process for themselves and their families. / Thesis (BA) — Boston College, 2012. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Communication Honors Program. / Discipline: Communication.

BACKGROUND: Inflammatory bowel disease (IBD) is a group of conditions characterized by chronic inflammation of the gastrointestinal (GI) tract. A new diagnosis of IBD in children and adolescents can have significant psychosocial effects on both the patient and the family. Child and parental coping strategies play a crucial role in the adjustment to IBD, especially within the first year of the diagnosis. AIMS: The primary aim of the study was to assess the stability of coping measures over time in children and parents following a new pediatric IBD diagnosis. The study also aimed to assess the impact of parental coping on parental healthcare resource utilization for children with newly diagnosed IBD, as well as the impact of parental coping on anxiety, depression, and quality of life in children with newly diagnosed IBD. METHODS: This was a prospective, longitudinal cohort study at Boston Children’s Hospital (BCH) that focused on children and adolescents with newly diagnosed IBD, as well as their parents. Patients and their parents were approached at the time they enrolled in the study and then again about 12 months later as part of a one-year follow-up. At both time points, they were asked to fill out various questionnaires about psychological functioning and answer other questions about medical care. RESULTS: The study identified and encountered 465 IBD patients, of which 126 were eligible for recruitment. There were 70 patients and families who signed a consent form for enrollment, 55 who fully or partially completed the questionnaires at baseline, and only 5 who also completed the questionnaires at follow-up. Due to the limited number of participants who completed the questionnaires at follow-up, no definitive conclusions could be drawn about the stability of coping measures over time. Parental anxiety, parental depression, frequent parental stress, and difficult parental stress were all found to be positively correlated with healthcare utilization and negatively correlated with the child’s quality of life. Parental anxiety, frequent parental stress, and difficult parental stress were all found to be positively correlated with the child’s anxiety. Parental depression, frequent parental stress, and difficult parental stress were all found to be positively correlated with the child’s depression. CONCLUSION: Preliminary findings suggest that poor parental coping leads to decreased child quality of life and increased healthcare utilization, child anxiety, and child depression. A larger sample size is needed to accurately evaluate the stability of coping measures over time. The next steps for this study involve further examination of the impact of parental coping and enrollment of more patients and families.

Aims: This study aims to explore the experience of osteoarthritis (OA) in older adults, drawing on concepts from the literature on chronic illness including social-cognition models (e.g. Self-Regulatory Model) and cognitive concepts (e.g. self-schema). Design and Participants: A qualitative research design and Phenomenological Interpretative Analysis Methodology were used. Sixteen participants were interviewed. Ten were recruited from an orthopaedic surgical waiting list source and six from a GP source: age ranged from 67 to 79 years, and history of osteoarthritis ranged from one to 35 years. Measures: A semi-structured interview schedule was designed and piloted, based on the research literature. Results: Analysis identified the following themes: Demands of OA (pain, impact on activity, and impact on mood); Perceptions ofOA (onset/deterioration, cause, label, seriousness, prognosis); Strategies to manage OA (use of health services, changes in behaviour, psychological strategies, appraisal of strategies); Perception of Self (compared to past/future/others) and Contextual factors (age, co-morbidity, waiting list). Links between themes were reciprocal, and a tentative model ofOA is presented. Implications: A comprehensive model of the experience of chronic illness could provide a framework to guide interventions for direct clinical interventions (e.g. adjustment to chronic illness, pain management, identification of psychological comorbidity) and indirect interventions (e.g. consultancy with other health professionals).

In this country little research has been undertaken into the vast array of difficulties faced by students and the stressors that contribute to them, particularly in the professions allied to medicine. A pilot study of 40 students revealed that the major difficulty was completion of coursework and the emotional state of students gave cause for concern too. Finance was also a recurring problem. In the main study, 210 students were given a Problem Questionnaire, the General Health Questionnaire 30 and the Glasgow Symptom Checklist. Emotional lability was a significant finding. This was often accompanied by self-destructive thoughts. Anxiety appeared to be a prime manifestation of unresolved stress. A considerable number of students found the burden of coursework more difficult than anticipated which led to serious consideration of dropping out. Financial suffering was evident, confirming earlier findings. Highly stressed students had closer affiliation to the psychiatric than the normal population. 45 students from the main study were able and willing to continue with the research. An unexpected discovery was that many of these students suffered deeply but the severity of psychological manifestations had little bearing on the final academic results. Of the 45, indepth case studies of sixteen Honours degree students were carried out to illustrate the degree of stress among students, identify particular stressors and look at the outcomes. Personality and coping mechanisms' questionnaires were administered together with the health and problem questionnaires. Findings showed a similar pattern to the sample of 45. Coping resources on their own did not supply a satisfactory answer. A more pertinent explanation appears to lie in a theory of activation incorporating the ascending reticular activating system. This was allied to motivational concepts and closely related to Eysenck's personality dimensions. Conclusions are that students need more specialised and prolonged help for their psychological difficulties.

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Background: Interest in resilience has rapidly increased over recent years because of its potential impact on health, well-being and quality of life. However, despite the increasing prevalence of dementia, there is a lack of resilience research involving people diagnosed with this condition. Therefore, little is known about what it is that enables people to live well with dementia and continue to lead successful and meaningful lives. Even small delays in the onset and progression of dementia have the potential to significantly reduce its global burden. More specifically, studies have shown an association between social engagement and reduced risk of cognitive decline and incident dementia and consequently there is growing interest in the effect of increasing social interaction on cognition. Objectives: This thesis comprises two parts. Initially, a systematic literature review summarises and evaluates the current empirical evidence to establish whether interventions which aim to increase social interaction can improve cognition in older adults. Secondly, a qualitative study aims to develop a grounded theory of the concept of resilience in people diagnosed with mild to moderate dementia. Methods: For the systematic review, a comprehensive list of electronic databases was systematically searched, relevant authors in the field were contacted and a hand search of relevant journals was conducted. For the qualitative study, seven semi-structured interviews were conducted with people diagnosed with dementia, with a social constructivist version of grounded theory informing the collection and analysis of data. Results: 17 studies met eligibility criteria for the systematic review, mostly of moderate quality. Study heterogeneity and methodological variability made it difficult to determine the specific contribution of social interaction to cognitive improvements. There was, however, tentative support for improvement in semantic fluency. The results of the qualitative study propose a model which hypothesises resilience is a process of ‘overcoming dementia’. For participants this meant maintaining a sense of pre- and post-diagnostic continuity which was achieved through a complex interaction of their approach to life and acceptance of dementia in conjunction with spousal and other social support. Conclusions: Although the systematic review found some evidence increased social interaction can improve cognition in older adults, this finding is tentative and should be interpreted with caution, with further research warranted. The qualitative study proposes a model of resilience which explains the process of ‘overcoming dementia’. Resilience is conceptualised as comprising individual, social, community, societal and cultural aspects and opens up the possibility of promoting resilience in people with dementia through the development of psychosocial interventions. This study emphasises the strengths and abilities of people with dementia, as well as the importance of social support, but most importantly it is from the perspective of the person with dementia.

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College students experience high levels of stress, especially those in health care programs. The purpose of this study was to determine what factors contribute to Tennessee radiography student stress levels and the methods by which they cope with stress. Additionally, do demographic factors affect radiography student stress levels? The research was conducted February 4 to March 30, 2016. A survey was distributed to students in a radiography program at two and four year colleges in Tennessee. Participants were asked questions on factors that influence their stress levels, coping strategies, and health issues experienced in the past year. Descriptive statistics, independent samples t-test, and Pearson correlations were used to determine what factors influenced student stress levels, the most effective coping strategies, and if demographics affected student stress levels. This analysis revealed that school causes students the most stress, while taking a break was the most used stress coping strategy.

We investigated the association of coping with quality of life (QoL) among parents of children with chronic illnesses, particularly inherited metabolic diseases (IMD); and whether coping may modify the association between caregiving complexity and parental QoL. In project 1, we systematically reviewed studies of parents of children with chronic illness. Among 10 eligible studies, we identified some evidence that adaptive coping strategies were positively associated with parental psychological QoL. In project 2, we analyzed data from a crosssectional mailed Canadian survey of parents of children <12 years of age with IMD. Among 113 respondents, greater emotion-focused coping was associated with lower mental QoL (all parents) and higher depressive symptoms (parents of children >=5 years). Analysis of significant interactions between coping and caregiving complexity did not reveal clear trends. Understanding the association of parental coping with QoL may help to inform interventions to promote parental health as part of family-centred care.